KENYA MEDICAL TRAINING COLLEGE

FACULTY OF PUBLIC HEALTH SCIENCES

DEPARTMENT OF NUTRITION AND DIETETICS

KNOWLEDGE,ATTITUDE AND PRACTICES OF BREASTFEEDING MOTHERS IN

MATERNAL CHILD HEALTH CLINIC IN RUIRU LEVEL 4 HOSPITAL, KIAMBU

COUNTY .

MERCY WACHIRA

COLLEGE NO:D/UPNUT/23002/080

A RESEARCH DISSERTATION SUBMITTED IN PARTIAL FULFILMENT FOR THE

DIPLOMA IN NUTRITION AND DIETETICS (UPGRADING) AT THE KENYA

MEDICAL TRAINING COLLEGE, KAREN CAMPUS.

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DEDICATION

I dedicate this research proposal to my friends for the support and encouragement they

have accorded me.

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ACKNOWLEDGEMENT

I give special thanks to the Almighty God for His guidance through my academics.

My appreciation to friends and family for their support and encouragement.

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DEFINATIONS

Breastfeeding – It is the act of feeding babies and young children with milk from a

woman’s breast.

Exclusive breastfeeding-breastfeeding of babies up to 6 months without giving anything

else with the exception of medicine.

Infant – A baby aged from birth up to one year.

Breast milk substitute – Any meal or food preparation especial formula to satisfy the

nutritional requirement of the baby up to 6 months of age.

Colostrum – Is a form of milk produced by mammary gland of mammal.

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CHAPTER ONE: INTRODUCTION

1:1 Background Information

Breastfeeding is also known as nursing. It is the feeding of babies and young children with

milk from a woman’s pbreast.Breastfeeding saves lives” and “Breast is best!” are well-

known slogans for physicians and women. Putting the newborn to the breast to nurse is

now considered “normative” in the United States with 75% of women doing so .

Unfortunately, breastfeeding as a way to continue to feed infants is not yet normative.

Women do not choose to breastfeed as long as recommended by health experts and the

government , which may result in a missed opportunity for improving infant health and, at

the same time, maternal health.

Health professionals recommend that breastfeeding begins within the first hour of a baby’s

life and continue as often and as much as the baby wants. Babies are supposed to

breastfeed at least 2-3 hours during the 1st few weeks of life. The duration of feeding is

usually 10 to 15 minutes on each breast.

According to World Health Organization (WHO), breastfeeding is exclusively

recommended for 6 months. This means that no other foods or drinks other than possible

vitamin D are typically. Breast milk provides the ideal nutrition for infants. It has all

perfect mix of vitamins, proteins and fat. Breast milk is also provided in a form more

easily digested than infant formula; it also contains antibiotics that help the baby fight off

viruses and bacteria. It lowers the baby’s risk of getting allergies plus babies exclusively

breastfed for the first 6 months without infant formula have fewer ear infections,

respiratory illnesses and episodes of diarrhea. Breastfeeding is also linked to higher IQ

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scores in later childhood in some studies. Breast milk also helps prevent risks of diabetes,

obesity and certain cancers. To the mother breastfeeding burns extra calories, so it can

help lose pregnancy weight faster, better uterus shrinkage, less postpartum depression. It

also delays the return of menstruation and fertility, decreased risk of cancer cardiovascular

disease and rheumatoid arthritis and it is less expensive and helps create a bond between

mother and child.

Factors known to affect breastfeeding are like socioeconomic status. New mothers who

struggle with their finances might make the decision to skip breastfeeding or wean at an

early age. According to Deborah Carter-Spaulding a professor in nursing, if a mother has

to return to work shortly after having a baby, she may choose not to breastfeed because it

is difficult to find time to pump and store breast milk at work. Postpartum emotions most

women experience some degree of the baby blues in the days and weeks following

delivery. According to the international journal of psychiatry in medicine woman with

severe symptoms may avoid caring for the infant, which includes making the choice no to

breastfeed. Many women experience postpartum depression as a result of weaning

adds.According to the US American Academy of Pediatrics (AAD), it is currently

recommended that infants should be fed breast milk exclusively for the first 6 months of

life. This means the infant doesn’t receive any additional foods (except vitamin D) or

fluids unless it’s medically recommended. AAP also recommends that after the first 6

months and until the infant is one-year-old, the mother should continue breastfeeding

while gradually introducing solid foods into the infant’s diet. The World Health

Organization infant feeding recommendation recommend that after the first 6 months to

meet their evolving nutrition requirements infants should receive nutritionally adequate

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and safe complementary foods while breastfeeding continues up to 2 years of age or

beyond.

UNICEF and WHO recommend the introduction of solid or semi solid food to infants

around age 6 months because by that age breast milk alone is no longer sufficient to

maintain a child’s optimal growth.

In the transition to eating the family diet, children from age 6 months should be fed small

quantities of solid and semisolid foods throughout the day while continuing to breastfeed

up to age 2 or beyond.In Kenya many parts of the county suffer from malnutrition

especially children due to poor breastfeeding habits and lack of knowledge on

breastfeeding but there are many counseling lessons to help mothers on how to breastfeed.

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 1.2 Problem Statement

Despite the extensive available information on the benefits of exclusive breastfeeding both

for the mother and the infant in Kenya, most children below 6 months are not exclusively

breastfed according to UNICEF (2014). The practice of breast feeding has continued to

decline despite the health education and formation of breastfeeding support groups

promoted by Ministry of health, therefore it is necessary to find out the knowledge,

attitude and practice of mothers on breastfeeding with later coming up with a solution that

would reverse the declining trend in breastfeeding practice and reducing mobility and

mortality rate.

1.3 Research questions

1. What factors influence breastfeeding practices among mothers attending MCHC in

Kenya? (Ong'wae et al.,2017)

2. What is the prevalence of exclusive breastfeeding among mothers in Kenya and factors

associated with exclusive breastfeeding?

(Karanja et al.,2017)

3. What is the impact of breastfeeding education and support provided at MCHC on

breastfeeding Initiation,duration and exclusivity among mothers in Kenya?

(Kimani-Murage et al.,2015)

1.4 Broad Objectives

i. To determine the knowledge, attitude and practices of breastfeeding mothers in

maternal child health in Ruiru Level 4 Hospital.

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 1.5 Specific Objectives

i. To determine the level of knowledge of mothers on the importance of

breastfeeding.

ii. To determine the attitudes of breastfeeding among the mothers.

iii. To determine the practices of breastfeeding mother.

iv. To determine the social-demographic factors of the breastfeeding mothers.

1.6 Study Justification

Exclusive breastfeeding is an important strategy for prevention of childhood morbidity

and mortality. WHO recommends that one should exclusively breastfeed for the first 6

months of life. Thus WHO/UNICEF baby friendly initiative developed the 10 steps to

successful breastfeeding to protect, support and promote breastfeeding.

Studies have been conducted on breastfeeding in different parts of the world in respect to

knowledge, attitude and practice. Breastfeeding will also help Kenya achieve sustainable

development goal number 2 which is zero hunger since breast milk is ready and always

available when the child wants and hence it will help reduce mortality rate in the country.

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1.7 Conceptual Framework

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CHAPTER TWO: LITERATURE REVIEW

Breastfeeding is the process by which human breast milk is fed to a child.It is the best way

of feeding all babies. It is an unequalled way of providing ideal food for the healthy

growth and development of infants. The Kenya National Maternal, Infant and Young

Child Nutrition Policy guidelines recommend that, infants should be exclusively breastfed

for the first six months of life to achieve optimal growth, development and health.

Virtually all mothers can breastfeed from birth provided they are given skilled practical

help, which can help to build their confidence, improve the feeding technique and prevent

or resolve breastfeeding problems.

The government of Kenya is committed to achieving global, regional and national targets

for nutrition which includes increasing the rate of breastfeeding by 50% by

2025.Approximately 823,000 lives of children could be saved annually by scaling up

breastfeeding. The early years of life are critical for child's growth and development i.e

physical, intellectual and emotional wellbeing (Rollins et al.,2016).Growing evidence also

suggests that it might protect against overweight and diabetes later in life(Horta et

al.,2015).

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Breastfeeding also has some benefits to the mother;prevention of breast cancer, enhanced

birth spacing and also narrowing the risk of diabetes(Hansen,2016).

Despite evidence that breastfeeding enhances unique health benefits to the child and the

mother,many children are inadequately breastfed due to various reasons.Kenya has high

breastfeeding rates, with 99% of babies ever breastfed but only 61% are exclusively fed

for the first 6 months of life. By the age four to 5 months 15% of infants are given other

milks in addition to breast milk and 27% have started receiving ofcomplementary foods.

Formula milk is expensive compared to most household incomes in Kenya so that animal

milk from locally kept livestock, e.g. cows, goats or camels, is more likely to be given.

Cows’ milk given in early infancy can lead to iron-deficiency anemia secondary to gastro-

intestinal tract irritation and blood loss, and dehydration secondary to high renal solute

load. Mixed fed infants under 6 months have a higher risk of diarrhea diseases as well as

malnutrition

A recent study of urban mothers living in informal settlements in Nairobi has shown low

uptake of the WHO recommendations on breastfeeding with very few working mothers

expressing breast milk (EBM) for caretakers to give their infants [6]. Poor urban mothers

in the informal labor market do not receive paid maternity leave and thus they are forced

to return to work leaving their infants, sometimes even in the first month of life, with

caretakers or in day care nurseries. These babies are given porridge and liquids other than

breast milk. There is little information available on the infant feeding strategies that rural

mothers in Kenya use when leaving their young infants with caretakers in order to work or

return to education

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2.2 Social demographic Factor

2.2.1 Maternal Age

According to the American journal of clinic and nutrition June 23 2006. First time mothers

who are older than 30, overweight or have breastfeeding difficulties on their newborns

first day may have increased odds of delay in their full breast milk production.

Older women who have given birth before have more knowledge about breastfeeding

since they learnt with their previous children according to (Macgor 2014).Young mothers

especially first time mothers have difficulties in breastfeeding and fear what others will

say about them hence may stop breastfeeding early (Coti et al 2013).

2.2.2 Education level

A woman educational and social class affects her motivation to breastfeed but the way it

affects is different in different parts of the word. It is most common among the educated in

the industrialized west countries. However, in the third world countries the educated class

women are more likely to feed their infants artificially (king et al, 2013).

Generally educated women tend to breastfed less and are likely to introduce

supplementary feeding earlier than the less educated. This is attributed to the fact that

better educated women are likely to work away from home which make breastfeeding

difficult (Luan, 2013). The Kenya Demographic Health Survey, KDHS 2022, found an

increasing relationship between education and mean duration of breastfeeding.

2.2.3 Marital status

Single mothers have great difficulty supporting themsel ves and caring for the baby

especially when they are young. Single mothers have less family support and without this

support, activities outside the home such as having to work might prevent exclusive

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breastfeeding and breastfeeding on demand. It is often better if the mother and baby stay

together and be supported as a family. They can breastfeed partially at least (Ebrahim

2009).

2.2.4 Employment
A woman can choose not to breastfeed because she plans to go back to work away from

home soon after the baby is born and feels it is too difficult to work and breastfeed. Other

women find it hard to maintain their milk supply when separated from their babies and

may be forced to stop breastfeeding (fisher et al, 2000). Maternal employment outside the

home is often cited as major factor in short term breastfeeding patterns seen throughout

the world (Perm, 2014).

2.3 Knowledge
Breastfeeding is essential for the health ofmothers and children (UNICEF,2018).It

promotes sensory and cognitive development and protects the baby against infectious and

chronic diseases.Colostrum is the baby's first immunization as it contains high levels of

antibodies,vitamin A and other protective factors (Mututho et al.,2017)

. The majority (95.7%) of the mothers knew that breast milk should be baby's first food,

while 87.4% knew that a baby should be put on a breast within one hour after delivery and

76.6% knew that colostrum should be given to the baby.

2.3.1 Duration
Most mothers who are well knowledgeable and mother who mostly stay at home know

that one should exclusively breastfeed their child for the first 6 months of life and hence

they apply it in real life since they spend most of time with their child.

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According to the WHO, exclusive breastfeeding is recommended for the first 6 months but

only 61% of infants are exclusively breastfed. Full time employed mothers don’t fully

breastfeed for 6 months. Longer breastfeeding duration is also associated with better

maternal infant feeding knowledge, attitudes and confidence according to (WHO, 2020).

A study in Greece found that material intention to breastfeed is influenced by maternity

leave provision, maternal age, and paternal education, the region of upbringing and season

of delivery.

2.3.2 Positioning of the baby

Most mothers are aware of different baby positions while breastfeeding. According to

(MYCF, 2012) there are different positions of holding the baby while breastfeeding such

as cross cuddle hold which is commonly used by most mothers. Football hold is less used

13.3%. Breast to baby latch and baby to breast latch is 41.3% most mothers agree that

neck flexion, slight back flexion arm support with pillow and foot rest are essential during

breastfeeding according to (WHO UNICEF, 0).

2.3.3 Importance to the mothers’ body

According to the American Academy of pediatrics (AAP 2022) breastfeeding is good to

mothers as those who breastfeed have a reduced risk of breast cancer, diabetes, heart

diseases, Osteoporosis and ovarian cancer. Breastfeeding also helps mother lose weight

gained during pregnancy. Mothers who don’t breastfed have to do a lot of exercise and to

be on diet to burn additional calories. Breastfeeding also helps the body release the

hormone oxytocin which help the uterus return to its pregnancy size and may reduce

uterine bleeding after birth.

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CHAPTER THREE: METHODOLOGY

3.1 Study Area

The study will be carried out in Kiambu county.It is the second most populous county in

Kenya after Nairobi County. Kiambu County borders Nairobi and Kajiado Counties to the

South, Machakos to the East, Murang'a to the North and North East, Nyandarua to the

North West, and Nakuru to the West.

Kiambu County is made up of twelve sub-counties namely, Githunguri, Kiambaa, Lari,

Limuru, Kabete, Gatundu North, Gatundu South, Juja, Kikuyu, Thika town, Ruiru and

Kiambu Town.

Ruiru sub county was purposely selected because of its population of approximately

371,111 persons based on the National Population Census,2019.

3.2 Study Population

The study population consists of women of child bearing age (15-50years) in Ruiru Level

4 Hospital.

3.3 Research Design

A descriptive cross-sectional study design will be used since the data collection is done at

one specific time. The descriptive is opted for since the study compares different

knowledge, attitudes and practices.

3.4 Sampling Procedure

Simple random sampling will be used whereby test of mother age (15-50 years) will be

obtained and then the sample of study determined from the list.

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3.5 Sample size Determinant

Fisher method will be used (Mugenda Mugenda, 2013)

n= z²/pq/d²

Where, n- is the desired sample size,

z- The standard normal deviation at the required confidence interval (95 probability error

equal to 1.96) ,p- The proportion of occurrence of the phenomenon (0.5 for unknown) ,q-

The proportion of non-occurrence is (1-p) = 0.5, d-The level of statistical significance

(0.05 for 95percent level of significance)

n= [(1.96)2× (0.5) (-0.5)/ (0.05)2] =384 n=384

When the population is less than 10000 the formula is Nf=n/1+ (n/N)

Where;

Nf – Is desirable sample when population is less than 10,000 n – Is sample when the total

population is more than 10,000

N –It is the estimated population of the area being studied

For example the population is 150 NF=n/ (1+ ((n-1)/N)) nf=__384 ______

1+ (384/150) =108

Therefore the sample consisted of 108 respondents

3.6 Data collection tools

Structured questionnaires will be used to obtain the data which are based on the objectives

of the topic.

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3.7 Data analysis

Statistical Package for Social Sciences (SPSS) and EXCEL shall be used to analyze the

data. The derivatives including frequencies, percentages and measures of central

tendencies for example mean, mode and median will be estimated. The results will be

presented using graphs, pie charts and tables.

3.8 Inclusion Criteria

Mothers who aged between ages 15-50 years and are willing to participate.

3.9 Exclusion Criteria

Mothers who are HIV positive and may not be willing to participate.

3.10 Ethical Consideration

Permission to carry out the research shall be obtained from NACOSTI and KMTC
department of Nutrition and Dietetics. The authority to conduct research will
obtained from medical superintendent of Ruiru Level 4 Hospital. A signed consent
by respondents will be given before the questionnaires are administered.
Confidentiality is to be maintained.

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CHAPTER 4: RESULTS

4.1 Respondents’ demographic presentation

Generally, the total number of respondents were 108. Statistical information during

analysis indicated that all the 108 respondents were captured in the data entry and analysis

stage. All the sample population were valid and none was missing.

4.1.1 Age
Majority of the respondents (37.96%) were between 26-45 years and the least (13.89%)

were 46-50 years

Figure 1: Mothers' ages

4.1.2 Marital status
From the results, the largest sample proportion (51.9%) were married. Those separated

formed the least part of group adding up to 7.4%.

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 4.1.3 Level of education
The results revealed that 38% of the mothers attended up to the level of primary school.

Secondary school composed 32.4% with 12% forming part of the university level. The

least (17.6%) did not attend any level of formal education.

4.1.4 Religion
From the study, majority of the respondents were Christians making 50% of sample

population. 25% were Muslims, 16% belonged to other religions while 8.3% did not

belong to any religion.

4.1.5 Occupation
Based on occupation of the respondents, majority (32.41%) were house wives, 28.7%

were business women that operated both large and small scale businesses, 24.07% were in

employment sectors while 14.81% did other jobs.

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 Figure 2:
Occupation of the respondents

4.2 Nutrition knowledge

4.2.1 Relationship between age and new born food

Different age categories of mothers responded to differently based on the feed the baby

should be given at birth. 62.04% preferred breast milk, 7.4% preferred formula milk at

birth, and 16.7% preferred cow’s milk while 13% preferred other feeds.

4.2.3 Sources of breast milk information in relation to the ages of the mothers

Different mothers based on their ages presented different sources of nutrition information.

Breast milk was statistically used as a determinant of the knowledge source. Women with

ages between 26-46 (25%) presented health personnel as their source of their information.

6.48% of this same age group presented relatives as their source compared to other age

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 groups. Based on symmetric measures on normal approximation, the study proved a very

strong relationship between age and the source of information.

4.3.2 Reasons for not breastfeeding for mothers of different academic levels

Out of the 108 mothers, 42 (38.89%) did not breastfeed. The results showed that the

attitude changed with academic level of the mothers. 40.48% said they had no milk, 4.76%

of the mothers said their husbands refused, 41.14% said their children stayed away from

them while 16.67% said that they did not breastfeed due to medical issues. The results also

indicated that those reasons were highly dependent on academic levels with majority of

children staying away from their mothers increased as the academic level of the mother

also increased.

Reason for not breastfeeding Total

Husband Child stays The mother is

Mother has no refused away from the sick
milk mother

Primary 7 0 2 2 11

Secondary 3 0 8 3 14

Level of education

University 3 1 3 1 8

None 4 1 3 1 9

Total 17 2 16 7 42

4.3.3 Exclusive breastfeeding age based on academic level of the mother

The study showed that mothers of different academic levels had different attitude on

breastfeeding ages. As the level advanced, their attitudes varied. Majority of the exclusive

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breastfeeding age up to 6 months (28.70%) was most preferred by the primary and

secondary school mothers. That dropped to 9.26% for the university mothers.

4.3.4 Attitude on breastfeeding as determined by the occupation of the mothers

Breastfeeding was determined by the occupation of the mothers. Considering breast milk,

the housewives (36.76%) of the mothers preferred it. That number reduced as the

occupation schedule became tighter with only 25% (business women) of the women and

23.52% (employed) among the women.

Table 4: New born food as determined by the occupation of the mothers.

New born food Total

Breastmilk Formula milk Cow milk Others

House wife 25 0 4 6 35

Business woman 17 4 4 6 31

Occupation

Employed 16 3 5 2 26

Others 10 1 5 0 16

Total 68 8 18 14 108

4.3.5: Current breastfeeding status in relation to the mother’s occupation

The study showed that mothers who were midwives (25.93%) breastfed the highest

number with least being the other occupation (7.41%). As occupation schedule became

tighter, most mothers dropped breastfeeding and adopted other methods.

4.3.6 Occupation and breastfeeding as an essential practice for child upbringing

Different mothers based on their occupation responded differently to breastfeeding as an

essential practice for child upbringing. Midwives (39.13%) strongly agreed compared to

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 business women (30.43%) and those employed (19.56%). Likewise, the employed (80%)

strongly disagreed as compared lto the housewives (0%) and business women (20%).

Breastfeeding as an essential practice for child upbringing Total

Agree strongly Agree Undecided Disagree Strongly disagree

House wife 18 10 4 3 0 35

Business woman 14 9 2 5 1 31

Occupation

Employed 9 2 3 8 4 26

Others 5 7 1 3 0 16

Total 46 28 10 19 5 108

4.4 Practice
4.4.1: Breastfeeding and marital status
Different mothers practiced different breastfeeding methods. They tied breastfeeding to

HIV infection therefore making them to either stop breastfeeding or introduce

complementary feeds at an earlier stage. Married couples strongly agreed to breastfeeding

compared to the widows and the divorced. Among them, married couples also showed a

higher percentage of uncertainty compared to the separated.

Table 6: Breastfeeding practices in relation to HIV transmission and infection

Breastfeeding may lead to HIV transmission Total

Agree Strongly Don’t

strongly Agree Disagree disagree know

Marital status Married 7 27 16 1 5 56

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 Single 2 10 4 2 3 21

Widow 1 8 4 0 1 14

Divorced 2 4 2 1 0 9

Separated 2 3 2 1 0 8

Total 14 52 28 5 9 108

4.4.2 Practice of feeding under 6 months with mothers of different marital status
Different feeding methods were presented by mothers of different marital status. Majority

of the married preferred breast milk compared to bottle milk or both. The single also

preferred breast milk with a substantial percentage going for both breast feeding and bottle

milk.

Table 7: Practice of feeding under 6 months with mothers of different marital status
Feeding under 6 months of age Total

Breast milk Bottle milk Both breast and bottle milk Others

Married 33 5
12 6 56
Single 12 1 6 2 21

Widow 7 2
3 2 14
Divorced 5 0 1 3
9
Marital status Separted 5 1
1 1 8
Total 62 9 14 108
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4.4.3 Practice on complementary feeding age
Different mothers introduced complementary feeds at different ages. That was determined

closely by their marital status. Most of the married mothers preferred complementary

feeds at 7 months compared to the single and the widows.

Complementary feeding age Total

4-6 months 7-12 months

Married 17 39 56

Single 10 11 21

Widow 3 11 14

Divorced 5 4 9
Marital
status Separted 6 2 8

Total 41 67 108

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CHAPTER FIVE: DISCUSSION

5.1 Socio-demographic presentation of the respondents

5.1.1 Age

The total number of respondents were 108 during data collection and statistical

analysis. All the sample population was valid. From the results, majority of the

respondents were between 26-45 years (37.96%) with the least (13.89%) were 46-

50 years. 21-25 years (31.48%) were the second largest group followed by women

of ages 15-20 years (13.89%).

5.1.2 Marital

On marital basis, 51.9% were married, 19.4% were single, 13.0% were widowed, 8.3 %

were divorced while 7.4% were separated. The majority of the respondents therefore

were married with the least group of the separated women.

5.1.3 Education background

Different mothers according to the study had either attempted formal education at

different levels while some had not. 38% of the mothers attended up to primary

school level, 32.4% secondary school, 12.0% University level while 17.6% did

not attempt any formal education. The larger sample population therefore

belonged to primary school as the highest level of education.

5.1.4 Religion

Based on religiosity, the respondents belonged to three major groups of religion:

Christianity, Islam and other religions that were unidentified and not disclosed. 50% were

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Christians, 25% were Muslims were 16% belonged to other religions. On the other hand,

8.3% of the mothers did not belong to any religion.

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5.1.5 Occupation

From the study, different respondents earned their daily lives from different duties/jobs.

Some were employed while some were not. Others belonged to different sectors while

others were personal managers. The results showed that 32.41% of the mothers were

housewives and depended on either their husbands or community for survival. 28.7% were

business women who had invested in different businesses from small scale to large scale.

They earned more than 80% of their income from their businesses. 24.07% were

employed at different sectors and were either managers or subjects while 14.81% were

jobless. The study further showed that majority of the respondents were housewives while

14.81% were jobless.

5.2 Nutrition Knowledge

5.2.1 Knowledge on new born food in respect to the mother’s age and education

The study showed that different mothers based on their age brackets preferred different

meals/foods for their new born. For the breast milk: majority of the mothers that preferred

it belonged to age bracket between 26-45 years (24/67). As the ages decreased towards 15-

20 years, the preference also decreased: 22/67 women of ages 21-25 years and 10/67

women of ages 15-20 years. Breast milk preference also reduced among the advanced

ages: 11/67 women of age between 46-50 years. The results also showed that cow milk

preference was higher among mothers of age between 26-45 years (9/18) and it decreased

as the age bracket decreased: 4/18 mothers of ages 21-25 and 3/18 of ages 15-20 years.

Formula milk preference did not show a regular trend since it was affected more by

academic and economic status than the age.

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Education wise, the research showed that majority of the mothers who preferred breast

milk as the newborn source of food belonged to primary and secondary school. It also

indicated that cow’s milk was preferred more among the mothers who attended primary

school as their highest education level compared to the secondary school mothers. Breast

milk was also least preferred among university school mothers as compared to the

secondary school mothers.Therefore,those who attended university recorded the least in

terms of breastmilk as the baby's sole food.

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Respondents had different opinions on breast milk characteristics and importance of breast

milk in relation to their ages. Among the mothers, 8.3% said breast milk had all nutrients,

13.89% said it was cheap and that it was always ready, 10.19% said it had the right

temperature, 5.56% said it was clean while 47.22% said it had all the listed benefits. Those

preferences were affected by the mothers’ ages. As the age advanced, the nutrition

knowledge on breast milk importance increased positively.

5.2.3 Sources of breast milk information

25% of women with ages between 26-45 years said they got the information from health

personnel while 6.48% said their source of information was from their relatives. The study

also showed that there was a very strong relationship between age of the respondents and

their source of information. The study showed that the health personnel were more valued

as the ages increased from 15 years up to 45 years after which they were lea valued again.

This might have come due to low level of aggressiveness among women of multiple child

births as compared to first time mothers who were willing to contact health practitioners

on more MCH issues.

5.3 Attitude
During the study, different mothers presented with different attitudes on breastfeeding.

The attitude was affected by age, education, economic status and socio demographic

factors.

5.3.1 Attitude of breastfeeding based academic grounds of the mother

Different mothers based on their academic status viewed breastfeeding differently.

On their current breastfeeding status, 27.78% of the mothers who breastfed attended

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primary school as while 19.44% were secondary school mothers. The results

indicated that as the mothers advanced from primary to secondary and finally to the

University, their attitude changed in that they least preferred breastfeeding. The

results indicated further that only 4.63% of the mothers with university academic

background preferred breastfeeding.

Out of the respondents, 42 (38.89%) mothers did not breastfeed and that was further

influenced by academic level. Among them, 40.48% said they had no milk, 4.76% said

their husbands refused, 41.14% said their children stayed away from them while16.67%

said they did not breastfeed due to medical issues. As mothers moved from primary to

university academic backgrounds, their reasons for not breastfeeding increased.

5.3.2 Exclusive breastfeeding age attitude as influenced by academic level of the mother

The study determined that as the academic level advanced, the mothers varied their

attitude: Exclusive breastfeeding age up to 6 months was highly preferred by the primary

and secondary school mothers (28.70%). The results showed that as the level increased to

university mothers, the attitude dropped only 9.26% of the mothers willing to

breastfeed.Therefore, the study showed that the willingness to exclusively breastfeed

reduced as the academic level increased.

5.3.3 Exclusive breastfeeding age attitude as influenced by the occupation of the mother
The study categorized the mothers into different occupation classes: the housewives,

business women, employed and the other categories of unidentified occupation. The

majority of the mothers (36.76%) who preferred breastfeeding were the housewives. The

business women did not prefer it as much as the housewives making up to only 25% of the

mothers. The employed women showed the least interest making up only 23.52% of the

31
women. The study therefore showed that the attitude was influenced by occupation of the

mothers. As their occupation became tighter in schedule, they less preferred both the

exclusive and general breastfeeding.

5.3.4 Current breastfeeding status in relation to the mother’s occupation

The mother’s occupation determined the current breastfeeding status of the mothers. The

study showed that majority of the current breastfeeding mothers (25.93%) were midwives

while the least being the other occupation (7.41%). The study also indicated that as the

occupation schedule became tighter, the mothers lost their interests in breastfeeding

showing a different change in attitude.

5.3.5 Breastfeeding attitude as essential practice for child upbringing based on

occupation.

Different mothers based on their occupation responded differently to breastfeeding as an

essential practice for child upbringing. Midwives (39.13%) strongly agreed compared to

business women (30.43%) and those employed (19.56%). Likewise, the employed (80%)

strongly disagreed as compared to the housewives (0%) and business women (20%).

These indicators showed that attitude towards breastfeeding as a good breastfeeding

practice was highly influenced by the mothers occupation.

5.4 Practice

5.4.1 Breastfeeding practice as influenced by the marital status of the mothers

Different mothers practiced different breastfeeding methods. They tied breastfeeding to

HIV infection therefore making them to either stop breastfeeding or introduce

complementary feeds at an earlier stage. Exclusive breastfeeding up to the age of six

32
months as a practice was also influenced by the marital status of the mothers. Married

couples (50%) strongly agreed to breastfeeding compared to the widows (7.14%) and the

divorced (14.29%). Among them, married couples (55.56%) also showed a higher

percentage of uncertainty compared to the separated (0%).

5.4.2 Practice of feeding under 6 months as determined by marital status, occupation and

academic level

Different feeding methods were presented by mothers of different marital status.

Majority of the married (33/62) preferred breast milk compared to bottle milk or both

(12/23). The single mothers (12/62) also preferred breast milk with a substantial

percentage (6/23) going for both breast feeding and bottle milk. The study also showed

that the majority of the mothers (36.76%) who preferred breastfeeding were the

housewives. The business women did not prefer it as much as the housewives making up

to only 25% of the mothers. The employed women showed the least interest making up

only 23.52% of the women. On the practice of their current breastfeeding status, 27.78%

of the mothers who breastfed attended primary school while 19.44% were secondary

school mothers. The results indicated that as the mothers advanced from primary to

secondary and finally to the University, their practice changed in that they least preferred

33
breastfeeding. The results indicated further that only 4.63% of the mothers with university

academic background preferred practicing breastfeeding.

5.4.3 Practice on complementary feeding age

Different mothers introduced complementary feeds at different ages. That was determined

closely by their marital status. Most of the married mothers preferred complementary

feeds at 7 months compared to the single and the widows.

The study therefore showed that complementary feeding was affected by academic

background, marital status and occupation of the mothers. The married mothers were more

willing to breastfeed their babies for a longer time compared to the single mothers and the

widows. This might have come due to the fact that they are single handed and they have to

meet all the obligations alongside breastfeeding.

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CHAPTER 6: CONCLUSION AND RECOMMENDATION
6.1 Conclusion
From the study done and the statistical data analysis conducted, it would be true to say that
breastfeeding is affected by several factors, some of which include socio demographic
factors: maternal age, marital status, occupation and education level, nutrition knowledge
and attitude: breastfeeding on demand, body image and cleanliness.
When all the above factors are consider and well balanced and managed, the result would
be good breastfeeding practices.
6.2 Recommendations
From the study, I would recommend the following:

 The mothers irrespective of their academic level be trained or informed on the

importance of breastfeeding. That may be done for example through the formation of
mother to mother groups.
 Single mothers to be encouraged by formation of business groups and treated in
support of their single handedness so that they may meet their daily needs and also
breastfeed their babies on demand.
 The employers to create baby friendly offices and places of work and also
breastfeeding corners so as to allow the mothers to continuously breastfeed their
babies even while at work.
 There should be open breastfeeding forums where mothers across the community
share experiences and learn more about importance of breastfeeding in relation to their
daily income and academic levels.

35
REFERENCES
American Academy of Pediatrics (AAP). (2012) Breastfeeding and the Use of Human
Milk Pediatrics, 129(3), C827e841.Retrieved April 27, 2012.Pstanly,
Mchungs, G Raman, P Cheo, N Magola, D Devines J.
Kids Health from Nemours. (2014) Weaning Your Child. Retrieved June 27, 2016.
American Academy of Paediatrics (2009) Breastfeeding. In Re Kleinman, Ed.
Pediatric Nutrition Handbook, 6thedpp 25-59 ELK Grove Village, IL.
UNICEF (2000) Booklet Baby Friendly Initiative.
La leche international Books. MC Kenna, James J and Thoman MC Dad 2005.
Stuebe AM, et al (2005) Duration of lactation and incidents diabetes type 2 JAMA, 294
(20): 2601-2610.
World health organization, Indicators for Assessing Infant and Young Child Feeding
Practices part 1 definition Geneva 2008.
WHO (2014) Baby Medley Hospital Initiative WHO/UNICEF (2012) Protecting
Promoting and Supporting Breastfeeding. The Special Role of Maternity
Services.
Duong D.U Binnr, CW and Lee, A.H. (2013) Breastfeeding initiation and exclusive
breastfeeding at the population level of baby friendly hospital initiative on
the promotion of exclusive breastfeeding among the Dhakar city dwelers
in Bang laddish mymensingh medical journal 11, 94-99).

36
APPENDICES
APPENDX 1: QUESTIONNAIRES
INTRODUCTION

I am Mercy Wachira from Kenya Medical Training College, pursuing Diploma in

Nutrition and Dietetics. I’ll ask you some questions about yourself, and so i am requesting
you to answer these questions appropriately. Whatever information you provide will be
kept private and confidential. However the research findings from this study may be made
available to persons who may seek to know.
SOCIAL DEMOGRAPHIC INFORMATION
Age
15 – 20
21 – 25
26 – 45
46 – 50
Marital status
Married
Single
Widow
Divorced
Separated

Level of education
Primary level
Secondary level
University level
None

Religion
Christian
Muslim
Others
None
Occupation
House wife
Business women
Salaries and employed
Others Specify ______________________

37
KNOWLEDGE OF BREASTFEEDING
What is the food for new born baby at birth?
Breast milk
Formula milk
Cow milk
Others Specify _____________________
What is the importance of breastfeeding?
Has all nutrients
Cheap
Always ready
Has right temperature
Clean
All
Where do you get information on breastfeeding?
Health personnel
Relatives

Others Specify ______________________

Is your child breastfeeding now

Yes
No
If no why?
I have no milk
My husband refused
Child doesn’t stay with me
I am sick

Others Specify ________________

What is the recommended age to stop breastfeeding?
0 – 6 months
7 – 12 months
13 – 18 months
19 – 24 months
Others Specify __________________

For how long is one supposed to breastfeed exclusively

0 – 6 months
0 – 1 year
0 – 2 years

38
At what month should one start
6 months
One year

Any time after birth

ATTITUDE ON BREASTFEEDING
Breastfeeding is an essential practice for up bringing a child, what do you think
Agree strongly
Agree
Undecided
Disagree
Strongly disagree
Others Specify __________________
Colostrum is very important for the baby
Strongly agree
Agree
Undecided
Disagree
Strongly disagree
Prolonged breastfeeding makes the child to refuse other food
Strongly agree
Agree
Disagree
Strongly disagree
Don’t know
Breastfeeding can be used as a method of family planning
Strongly agree
Agree
Disagree
Strongly disagree
Children whose mothers are HIV positive who breastfeed are likely to develop
HIV. What do you think?
Strongly agree
Agree
Disagree
Strongly disagree
Don’t know

39
What are some of the reasons why some mothers don’t breastfeed?
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_________________

What are some of the practices and beliefs that stop mothers
from breastfeeding their baby?
_____________________________________________________________
_______________________________________________________________

PRACTICE ON BREASTFEEDING
How do you feed your baby under 6 months?
Breast milk
Bottle milk
Both breast and bottle milk
Others Specify ____________________
At what time did you breastfeed your child after delivery?
Immediately after birth

After 1 – 2 hours
Within 30 minutes afterbirth
Others Specify __________________
At what age did you start giving other than breast milk?
0 - 3 months
4 - 6 months
7 - 12 months

40
 APPENDIX 2: BUDGET

ITEMS QUANTITY AMOUNTS (KSHS)

Biro pens 5 @ 10 50

Pencils 2 @ 20 40

Rulers 1@ 30 30

Photocopying papers 2 reams @ 500 1000

Total

Typing and computer

services

Flash disk 1 @2000 2000

Browsing internet 600

Typing research 30 @ 30 900

Binding research 2 @ 200 400

Printing presentation 30 @ 10 300

Subtotal 3900

Travelling and lunch

Travelling to study area 700 700

Lunch 100 x 14 1400

TOTAL 7,120

41
 APPENDIX 3: WORK PLAN

TIME/ACTIVITY MAY JULY DEC JAN- JUNE

APRIL
2023 2023 2023 2024
2024

Writing research proposal

Submission of research
proposal

Data collection

Data analysis, discussions

and interpretation

Printing, production and

submission of research
dissertation.

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APPENDIX 4: MAP OF KIAMBU COUNTY

43
APPENDIX 5: KMTC LETTER

APPENDIX 6:A LETTER FROM THE COUNTY COMMISSIONER

44
APPENDIX 7: NACOSTI

45
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